Breast Cancer: Diagnostic Imaging and Therapeutic Guidance

Breast Cancer: Diagnostic Imaging and Therapeutic Guidance
Title Page
Copyright
Contents
Preface
Contributors
Abbreviations
Part 1: Anatomy, Physiology, and Pathology of the Breast
	1 Development, Anatomy, and Physiology of the Mammary Gland
		1.1 Development
		1.2 Anatomy
		1.3 Physiology
		Bibliography
	2 Tumor Formation
		2.1 Mutation, Carcinogenesis, and Angiogenesis
		2.2 Risk Factors
		2.3 Genetic Risk Factors
		2.4 Prevention
			2.4.1 Primary Prevention
			2.4.2 Secondary Prevention
			2.4.3 Tertiary Prevention
		2.5 Epidemiology, Incidence, and Mortality
		Bibliography
	3 Pathology of Benign and Malignant Changes in the Breast
		3.1 Benign Changes
			3.1.1 Histological Principles
			3.1.2 Nonneoplastic, Nonproliferative Diseases of the Breast
			3.1.3 Benign Tumor-Forming Diseases
		3.2 Malignant Changes in the Breast
			3.2.1 Classification of Malignant Breast Tumors (WHO Classification, B-Categories)
			3.2.2 Prognostic and Predictive Factors
			3.2.3 Papillary Lesions
			3.2.4 Ductal Carcinoma In Situ
			3.2.5 Microinvasive and Invasive Breast Carcinoma
			3.2.6 Tumors of the Nipple
			3.2.7 Malignant Mesenchymal Tumors and Lymphomas of the Breast
			3.2.8 Metastatic Tumors
		3.3 Acknowledgments
		Bibliography
Part 2: Breast Diagnostics
	4 Nonimaging Diagnostics
		4.1 History
		4.2 Informed Consent
		4.3 Self-Examination
		4.4 Inspection
		4.5 Palpation
		Bibliography
	5 Mammography
		5.1 Technique and Methods
			5.1.1 Principles of X-ray Mammography
			5.1.2 Components of a Mammography System
			5.1.3 Exposure Parameters
			5.1.4 Image Quality
			5.1.5 Analog Mammography
			5.1.6 Digital Mammography
			5.1.7 Radiation Exposure
		5.2 Parameters and Positioning
			5.2.1 Standard Projections
			5.2.2 Supplementary Views
			5.2.3 Galactography
			5.2.4 Mammography of the Male Breast
			5.2.5 Quality Assurance in Parameters and Positioning
		5.3 Interpretation of Mammograms
			5.3.1 Terminology
			5.3.2 Tissue Density in a Mammogram According to the ACR BI-RADS Atlas
			5.3.3 Interpretation Criteria
			5.3.4 BI-RADS Classification of Mammography
			5.3.5 Normal Findings in the Mammogram
		Bibliography
	6 Breast Ultrasonography
		6.1 Technique and Methods
			6.1.1 Basic Principles
			6.1.2 Device Adjustments
			6.1.3 Examination Technique
			6.1.4 Ultrasound Techniques
			6.1.5 Quality Assurance
		6.2 Evaluation
			6.2.1 Terminology
			6.2.2 Tissue Type in Sonography
			6.2.3 Evaluation Criteria
			6.2.4 BI-RADS Classification of Breast Ultrasonography
			6.2.5 Normal Findings in Sonography
		Bibliography
	7 Magnetic Resonance Imaging of the Breast
		7.1 Technique and Methods
			7.1.1 Basic Principles
			7.1.2 Tumor Detection
			7.1.3 Equipment
			7.1.4 Timing of the Examination
			7.1.5 Patient Positioning
			7.1.6 Measurement Parameters
			7.1.7 Image Postprocessing
			7.1.8 Implant Evaluation
			7.1.9 Nonestablished Examination Techniques
		7.2 Evaluation
			7.2.1 Terminology
			7.2.2 Perfusion Pattern
			7.2.3 Findings in the T1-Weighted Precontrast Image
			7.2.4 Findings in the T2-Weighted Image
			7.2.5 Findings in the T1-Weighted Contrast-Enhanced Image
			7.2.6 Evaluation Criteria
			7.2.7 BI-RADS Classification of MRI of the Breast
			7.2.8 Normal Findings in MRI of the Breast
		Bibliography
	8 Imaging of Breast Lesions
		8.1 Benign Findings
			8.1.1 Cysts
			8.1.2 Inflamed Cysts
			8.1.3 Complex Cysts
			8.1.4 Myxoid Fibroadenoma
			8.1.5 Fibrotic Fibroadenoma
			8.1.6 Adenoma
			8.1.7 Hamartoma
			8.1.8 Lipoma
			8.1.9 Mammary Fibrosis
			8.1.10 Adenosis of the Breast
			8.1.11 Fibrocystic Condition of the Breast
			8.1.12 Adenomyoepithelioma
			8.1.13 Acute Nonpuerperal Mastitis
			8.1.14 Chronic Nonpuerperal Mastitis
			8.1.15 Intramammary Lymph Nodes
			8.1.16 Pseudoangiomatous Stromal Hyperplasia
			8.1.17 Seroma
			8.1.18 Hematoma
			8.1.19 Fat Necrosis (Oil Cyst)
			8.1.20 Abscess
			8.1.21 Postoperative Scars
		8.2 Findings with Ambiguous Biological Potential
			8.2.1 Papillomas
			8.2.2 Radial Scars
			8.2.3 Atypical Ductal Hyperplasia
			8.2.4 Phyllodes Tumors
			8.2.5 Cysts with Intracystic Proliferation
			8.2.6 Lobular Intraepithelial Neoplasia
		8.3 Intraductal Carcinoma
			8.3.1 Ductal Carcinoma In Situ (Low Grade)
			8.3.2 Ductal Carcinoma In Situ (Intermediate Type)
			8.3.3 Ductal Carcinoma In Situ (High Grade)
		8.4 Invasive Tumors
			8.4.1 Invasive Ductal Carcinoma
			8.4.2 Invasive Lobular Carcinoma
			8.4.3 Tubular Carcinoma
			8.4.4 Medullary Carcinoma
			8.4.5 Mucinous Carcinoma
			8.4.6 Invasive Papillary Carcinoma
			8.4.7 Sarcomas
			8.4.8 Triple-Negative Carcinoma
			8.4.9 Paget’s Disease of the Nipple
			8.4.10 Inflammatory Carcinoma
			8.4.11 Systemic Diseases Involving the Breast
	9 Breast Intervention
		9.1 Biopsy
			9.1.1 Objective of Percutaneous Tissue Sampling
			9.1.2 Percutaneous Tissue Sampling Equipment and Implementation
			9.1.3 Interventional Imaging
			9.1.4 Classification of Findings
			9.1.5 Tumor Seeding and Mechanical Tumor Induction
			9.1.6 Quality Assurance
		9.2 Localization
			9.2.1 Objective of Pretherapeutic Localization
			9.2.2 Equipment and Implementation
			9.2.3 Quality Assurance
		Bibliography
Part 3: Prevention and Therapy of Breast Cancer
	10 Examination Concepts
		10.1 Prevention
		10.2 Early Breast Cancer Detection (Secondary Prevention)
			10.2.1 Mammography Screening
			10.2.2 Individualized Examination Concepts
			10.2.3 Early Detection inWomen with a High-Risk Profile
			10.2.4 Future Concepts of Early Breast Cancer Detection
		10.3 Diagnostic Work-up
		10.4 Pretherapeutic Local Staging
		10.5 Pretherapeutic Peripheral Staging
		10.6 Follow-up Care
		10.7 Implant Evaluation
		10.8 Evaluation of the Male Breast
		Bibliography
	11 Surgical Treatment of Breast Carcinoma
		11.1 Significance of Surgery in the Context of Multimodal Treatment of Breast Carcinoma
		11.2 Types of Breast Carcinoma
			11.2.1 Lesions of Uncertain Biological Potential (B3 Lesions)
			11.2.2 Preinvasive Carcinoma (Ductal Carcinoma in Situ; B5a)
			11.2.3 Invasive Carcinoma (B5b)
		11.3 Surgical Treatment of the Primary Lesion
			11.3.1 Oncologic Aspects
			11.3.2 Technical Aspects
		11.4 Lymph Node Surgery
			11.4.1 Procedure for Clinically Negative Node Status
			11.4.2 Procedure for Clinically Positive Nodal Status
			11.4.3 Procedure for Clinically Negative Node Status and Positive Sentinel Node
		11.5 Secondary Breast Reconstruction
			11.5.1 Timing the Reconstruction: Primary vs. Secondary Reconstruction
			11.5.2 Alloplastic Reconstruction (Implant Reconstruction)
			11.5.3 Autologous Reconstruction (Reconstruction Using Endogenous Tissue)
			11.5.4 Nipple Reconstruction
		Bibliography
	12 Medical Treatment of Breast Cancer
		12.1 Basic Principles and Objectives
		12.2 Adjuvant Drug Therapy
			12.2.1 Adjuvant Chemotherapy
			12.2.2 Neoadjuvant Therapy
			12.2.3 Adjuvant Endocrine Therapy
			12.2.4 Antibody Therapy
		12.3 Medical Treatment in Locoregional Recurrence
		12.4 Medical Treatment of Distant Metastases
			12.4.1 Endocrine Therapy in Premenopausal Patients with Distant Metastases
			12.4.2 Endocrine Therapy in Postmenopausal Patients with Distant Metastases
		12.5 Endocrine Maintenance Therapy after Completing Chemotherapy
		12.6 Chemotherapy of Metastatic Breast Cancer Combined with New Agents
		Bibliography
	13 Radiotherapy of Breast Cancer
		13.1 Adjuvant Radiotherapy after Breast-Conserving Surgery
		13.2 Adjuvant Radiotherapy after Mastectomy
		13.3 Effectiveness of Adjuvant Radiation Therapy: Prognostic Factors
		13.4 Integration of Adjuvant Radiotherapy into the Multimodal Treatment Concept
		13.5 Target Volume and Dose Concept
			13.5.1 Clinical Target Volume: Former Tumor Region, Mammary Gland, Chest Wall, and Regional Lymph Channels
			13.5.2 Partial Breast Irradiation
			13.5.3 Shortened Treatment Time: Alternative Fractionation Schemes
		13.6 Acute Side Effects and Complications of Adjuvant Radiation Therapy
			13.6.1 Acute Side Effects
			13.6.2 Late Complications of Radiation Therapy
		13.7 Planning and Implementing Radiation Therapy
		13.8 Radiotherapy in Primarily Inoperable Tumors, Recurrences, and Metastatic Disease
		13.9 Summary
		Bibliography
	14 Management of a Diagnostic Breast Center
		14.1 Expertise
		14.2 Equipment
		14.3 Facility Design
			14.3.1 Doctor’s Consultation Room
			14.3.2 Mammography and Sonography Rooms
			14.3.3 Breast MRI Room
			14.3.4 Rooms for a Second Ultrasound Unit and for Interventional Procedures
			14.3.5 Recovery Room
		14.4 Ambiance
		14.5 Communication
	15 Logistics in an Interdisciplinary Breast Center
		15.1 Background
		15.2 Structure of a Certified Breast Center
		15.3 Treatment Pathways in a Breast Center
		15.4 Outlook
		Bibliography
	16 Counseling Techniques and Psychosocial Support
		16.1 Compliance
			16.1.1 Quality of the Medical Services
			16.1.2 General and Personal Requirements
			16.1.3 Structural, Organizational, and Procedural Components
			16.1.4 Interactive and Communicative Competence
		16.2 Communication
			16.2.1 General Principles of Communication
			16.2.2 Communication: Dealing with the Patient
			16.2.3 Communicating Results to the Patient
		16.3 The Patient’s Flow through the Department
			16.3.1 Station 1: Registration
			16.3.2 Station 2: History and Physical Examination
			16.3.3 Station 3: The Diagnostic Procedure
			16.3.4 Station 4: Communication of Results and Concluding Consultation
		16.4 Summary
		Bibliography
Index